Association between Dietary Acid Load and Hyperuricemia in Chinese Adults: Analysis of the China Health and Nutrition Survey (2009).

BACKGROUND: This study evaluates the association between dietary acid load (DAL) and hyperuricemia in Chinese adults. METHODS: The China Health and Nutrition Survey (CHNS) in 2009 was used in this cross-sectional study. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) were applied to estimate DAL. A multiple logistic regression model was used to test the relationship between DAL and hyperuricemia risk. RESULTS: A total of 7947 participants were included in this study, of whom 1172 had hyperuricemia. The PRAL score was positively related to the prevalence of hyperuricemia, even when potential covariates were taken into account. In comparison with Q1, the ORs were 1.12 (95% CI, 0.92-1.38), 1.20 (95% CI, 0.97-1.47) and 1.42 (95% CI, 1.16-1.75) in Q2, Q3 and Q4. However, there was no significant relationship between NEAP scores and hyperuricemia. Every 10 g increase in energy-adjusted fat, protein and animal protein intakes caused a 10%, 17% and 18% increase in hyperuricemia risk, respectively (OR: 1.10, 95% CI: 1.04-1.16; OR: 1.17, 95% CI: 1.11-1.25; OR: 1.18, 95% CI: 1.12-1.24, respectively). An obvious linear correlation was also suggested by the restricted cubic spline. CONCLUSIONS: Hyperuricemia risk was associated with higher PRAL among Chinese adults. This means that a diet low in PRAL scores could be a very valuable uric acid-lowering dietary pattern.

cMIND Diet, Indoor Air Pollution, and Depression: A Cohort Study Based on the CLHLS from 2011 to 2018.

This study aims to explore the interaction between a Chinese version of the Mediterranean-DASH intervention for neurodegenerative delay (cMIND) diet and indoor air pollution and its effect on depression among older adults. This cohort study used 2011-2018 data from the Chinese Longitudinal Healthy Longevity Survey. Participants included 2724 adults aged 65 and older without depression. The Chinese version of the Mediterranean-DASH intervention for neurodegenerative delay (cMIND) diet scores ranged from 0 to 12 based on validated food frequency questionnaire responses. Depression was measured using the Phenotypes and eXposures Toolkit. Cox proportional hazards regression models were used to explore the associations, and the analysis was stratified using the cMIND diet scores. A total of 2724 participants (54.3% males and 45.9% 80 years and older) at baseline were included. Living with severe indoor pollution was associated with a 40% increase in the risk of depression (HR: 1.40, 95% CI: 1.07, 1.82) compared to living without indoor pollution. Indoor air pollution exposure was significantly associated with cMIND diet scores. Participants with a lower cMIND diet score (HR: 1.72, 95% CI: 1.24, 2.38) had a greater association with severe pollution than those with a higher cMIND diet score. The cMIND diet may alleviate depression caused by indoor pollution among older adults.

Anti-Hyperuricemic Effect of Anserine Based on the Gut-Kidney Axis: Integrated Analysis of Metagenomics and Metabolomics.

Nowadays, developing effective intervention substances for hyperuricemia has become a public health issue. Herein, the therapeutic ability of anserine, a bioactive peptide, was validated through a comprehensive multiomics analysis of a rat model of hyperuricemia. Anserine was observed to improve liver and kidney function and modulate urate-related transporter expressions in the kidneys. Urine metabolomics showed that 15 and 9 metabolites were significantly increased and decreased, respectively, in hyperuricemic rats after the anserine intervention. Key metabolites such as fructose, xylose, methionine, erythronic acid, glucaric acid, pipecolic acid and trans-ferulic acid were associated with ameliorating kidney injury. Additionally, anserine regularly changed the gut microbiota, thereby ameliorating purine metabolism abnormalities and alleviating inflammatory responses. The integrated multiomics analysis indicated that Saccharomyces, Parasutterella excrementihominis and Emergencia timonensis were strongly associated with key differential metabolites. Therefore, we propose that anserine improved hyperuricemia via the gut-kidney axis, highlighting its potential in preventing and treating hyperuricemia.

Multi-omics analysis reveals therapeutic effects of Bacillus subtilis-fermented Astragalus membranaceus in hyperuricemia via modulation of gut microbiota.

At present, uncovering how to preventandcontrol hyperuricemia has become an important public health issue. Fermented traditionalChinesemedicine has exhibited promising applications in the clinical management of hyperuricemia. In this study, we generated a hyperuricemic mouse model to explore the potent therapeutic ability of Bacillus subtilis-fermented Astragalus membranaceus (BFA) on this condition by multi-omics analysis. We found that the serum uric acid level was decreased in hyperuricemic mice after BFA treatment. BFA effectively attenuated renal inflammation and regulated the expression of urate transporters. Additionally, we found that BFA could increase the abundances of butyrate-producing bacteria, including Butyricimonas synergistica, Odoribacter splanchnicus, and Collinsella tanakaei, and probiotics, including Lactobacillus intestinalis and Bacillus mycoides, in hyperuricemic mice. Therefore, we believe that BFA has the potential to become a novel safe and valid functional food for addressing hyperuricemia.

Sulforaphane-driven reprogramming of gut microbiome and metabolome ameliorates the progression of hyperuricemia.

INTRODUCTION: Currently, revealing how to prevent and control hyperuricemia has become an essential public health issue. Sulforaphane hasawiderangeofapplications in the management of hyperuricemia. OBJECTIVE: The study objective was to verify the uric acid-lowering effects and the regulation of the gut-kidney axis mediated by sulforaphane and identify host-microbial co-metabolites in hyperuricemia. METHODS: A hyperuricemia model was established by administering feedstuffs with 4% potassium oxonate and 20% yeast. Forty male Sprague-Dawley rats were randomly divided into the normal control, hyperuricemia, allopurinol, and sulforaphane groups. Animals were treated by oral gavage for six consecutive weeks, and then phenotypic parameters, metabolomic profiling, and metagenomicsequencing were performed. RESULTS: Sulforaphane could lower uric acid by decreasing urate synthesis and increasing renal urate excretion in hyperuricemic rats (P＜0.05). We identified succinic acid and oxoglutaric acid as critical host-gut microbiome co-metabolites. Moreover, sulforaphane improved the diversity of microbial ecosystems and functions, as well as metabolic control of the kidney. Notably, sulforaphane exerted its renoprotective effect through epigenetic modification of Nrf2 and interaction between gut microbiota and epigenetic modification in hyperuricemic rats. CONCLUSION: We revealed that sulforaphane could ameliorate the progression of hyperuricemia by reprogramming the gut microbiome and metabolome. Our findings may provide a good means for efficiently preventing and treating hyperuricemia.

Long-Term High Dietary Diversity Maintains Good Physical Function in Chinese Elderly: A Cohort Study Based on CLHLS from 2011 to 2018.

(1) Objective: This study aimed to explore the correlation between dietary factors and physical function in Chinese elderly. (2) Methods: A cohort study was conducted on the association of long-term dietary intake status with physical function in older people based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2011 to 2018. The physical function of the subjects was judged according to the scores of basic activities of daily living (BADL) and instrumental activities of daily living (IADL). The dietary diversity score was established according to the intake frequency of the food groups, and the dietary pattern score was obtained by factor analysis. The associations between dietary factors and functional impairment was investigated by logistic regressions. (3) Results: A total of 2282 subjects were included in our cohort study, 458 and 1439 of whom had BADL limitation and IADL limitation, respectively. The risk of functional impairment decreased in the consistent high dietary diversity groups compared with the consistent low dietary diversity group (p < 0.05). The fruit-egg-milk pattern, vegetable-meat-fish pattern, and condiment and tea pattern reduced the risk of functional impairment (p < 0.05). (4) Conclusions: Long-term maintenance of high dietary diversity and increasing total dietary intake can help maintain good physical function of Chinese elderly.

Oat ß Glucan Ameliorates Renal Function and Gut Microbiota in Diabetic Rats.

Diabetic nephropathy is a severe complication of diabetes and the leading cause of end-stage renal disease and death. Therefore, we must find effective prevention and treatment approaches to the problem. Oat has a long history of use for its nutritional and medicinal properties, such as maintaining physiological blood glucose levels. Oat ß glucan is one of the major bioactive substances produced by oat. However, the protective effects of oat ß glucan on diabetic nephropathy are still unclear. This study generated a rat model of diabetic nephropathy to explore the potent therapeutic ability and mechanism of oat ß glucan in renal function by 16S rRNA genes sequencing. Diabetic nephropathy model was established in forty rats by left nephrectomy and single intraperitoneal injection of streptozotocin. These rats were randomly divided into the model group and three oat ß glucan intervention groups. Twenty rats underwent sham operation and were randomly divided into normal control group and oat ß glucan control group. Animals were treated by oral gavage for 8 consecutive weeks. The results showed that oat ß glucan reduced blood glucose level and improved renal function (P < 0.05). Oat ß glucan significantly improved serum inflammatory levels (P < 0.05). The diversity of intestinal microflora in diabetic nephropathy rats decreased with time prolongation, while oat ß-glucan reversed the result. Compared with the model group at week 8, the abundances of Eubacterium, Butyricicoccus, and Ruminococcus were elevated significantly after oat ß glucan intervention (P < 0.05). Correlation analysis indicated that abundances of Eubacterium, Butyricicoccus, and Ruminococcus were significantly negatively correlated with the levels of renal impairment markers. In summary, the findings of this study showed that oat ß glucan can increase the diversity of intestinal flora, regulate the composition of intestinal flora, modulate intestinal flora metabolism, alleviate the inflammatory response, and further delay the development of diabetic nephropathy. Therefore, oat ß glucan has the potential to be developed into the novel and safe drug for diabetic nephropathy.

Sarcopenia and catastrophic health expenditure by socio-economic groups in China: an analysis of household-based panel data.

BACKGROUND: Sarcopenia was thought to be associated with adverse outcomes and will cause lots of health expenditure. But the relationship between sarcopenia and catastrophic health expenditure (CHE) had been little explored. Here, we examined the distribution of sarcopenia in relation to medical and payment burdens. METHODS: We used data from three waves of China Health and Retirement Longitudinal Study including 14 130 participants from 9077 households aged over 50 years old. Sarcopenia was operationalized according to the Asian Working Group for Sarcopenia 2019. Medical expenditure was obtained by self-reported data, and CHE was identified by WHO definitions. We used the negative binomial regression model and logistic mixed-effects models to examine the associations between sarcopenia and medical and CHE. RESULTS: A total of 14 130 participants [52.2% female, aged 60.8 (SD 9.3)] from 9077 households were included in this study. The prevalence of sarcopenia was 19.8%, 11.9% for moderate sarcopenia, and 7.9% for severe sarcopenia, respectively. We identified 1416 household CHE events in all three waves. Severe sarcopenia was associated with an increase in the number of inpatient visits [incidence rate ratio 1.31, 95% confidence interval (CI): 1.03-1.66, P = 0.03] and the risk of CHE (odds ratio: 1.04, 95% CI: 1.01-1.07, P < 0.01). We saw similar effects in health service use of sarcopenia in different socio-economic groups. Moderate sarcopenia increased the risk of CHE in the lowest socio-economic group (odds ratio 1.03, 95% CI: 1.01-1.06, P = 0.03) and had no statistical significance in other groups. The association between severe sarcopenia and CHE did not attenuate after the adjustment of disease factors. CONCLUSIONS: Severe sarcopenia may increase the risk of CHE. Timely and effective intervention on moderate sarcopenia from severe sarcopenia will contribute to reduce the health burden.

Development and Validation of Nutrition Literacy Questionnaire for the Chinese Elderly.

(1) Background: Improving nutrition literacy is crucial for maintaining a healthier state of the elderly to achieve healthy ageing. Therefore, it is necessary to develop a Nutrition Literacy Questionnaire for the Chinese Elderly (NLQ-E). (2) Methods: an NLQ-E was developed according to the core components of nutrition literacy for the elderly. Internal consistency, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to validate the reliability and validity of the NLQ-E. A cross-sectional study of 1490 elderly people was used to analyze the application of the NLQ-E. (3) Results: The NLQ-E was constructed with 3 domains (knowledge and understanding, healthy lifestyle and dietary behavior and skill), with a total of 25 questions. The overall NLQ-E had acceptable reliability and validity (Cronbach's α = 0.678, χ2/DF = 4.750, RMSEA = 0.045, PCFI = 0.776 and PNFI = 0.759). The average nutrition literacy score of the subjects in this cross-sectional study was 65.95 (65.95 ± 10.93). The OR between the nutrition literacy score and multimorbidity was 0.965 (95% CI: 0.954, 0.976); (4) Conclusions: We developed and validated the NLQ-E and found that the nutrition literacy level of the Chinese elderly was generally low. This study is of great value to improve the nutrition literacy of the elderly and effectively prevent nutrition-related chronic diseases and multimorbidity.

Dietary Inflammatory Index and the Risk of Hyperuricemia: A Cross-Sectional Study in Chinese Adult Residents.

BACKGROUND: Dietary Inflammatory Index (DII) scores have been consistently associated with several chronic diseases. This study explored the correlation between the DII and hyperuricemia in Chinese adult residents. METHODS: The study included 7880 participants from the China Health and Nutrition Survey (CHNS), which was taken in in 2009. A 3-day 24 h meal review method was used to collect diet data and to calculate the DII score. Serum uric acid was obtained to determine hyperuricemia levels. Subjects were divided into a hyperuricemia group and a non-hyperuricemia group, according to their serum uric acid level. Multilevel logistic regression models were used to examine the association between DII scores and hyperuricemia. RESULTS: After adjusting for covariates, a higher DII score was determined to be associated with a higher risk of hyperuricemia. Compared to those in the highest DII score group, the lower DII score group had an inverse association with hyperuricemia risk (Q2: 0.83, 95% CI: 0.70-0.99; Q3: 0.72, 95% CI: 0.60-0.86; Q4: 0.73, 95% CI: 0.61-0.88). The intake of energy-adjusted protein, total fat, MUFAs, PUFAs and saturated fatty acid was higher in the hyperuricemia group. CONCLUSIONS: A higher DII score is significantly associated with a higher risk of hyperuricemia. Controlling the intake of pro-inflammatory food may be beneficial to reduce the risk of hyperuricemia.

Associations between Early-Life Food Deprivation and Risk of Frailty of Middle-Age and Elderly People: Evidence from the China Health and Retirement Longitudinal Study.

BACKGROUND: The association between childhood food deprivation (FD) and health in later life has been extensively studied; however, studies on the association between childhood food deprivation and frailty are scarce. This study assessed the associations between childhood FD and the risk of frailty at middle-age and old age. METHODS: Three waves of the China Health and Retirement Longitudinal Study (CHARLS), including 11,615 individuals aged over 45 years, were used for this research. Frailty was operationalized according to the FRAIL scale as a sum of fatigue, resistance, ambulation, illness, and the loss of weight. Childhood FD experiences and levels were measured by self-reported FD and historical content. Logistic mixed-effects models and proportional odds ordered logistic regression models were used to analyse the association between childhood FD and frailty. FINDINGS: Childhood FD increased the odds of frailty at old age (1.30, 95% CI: 1.26-1.36). Compared with subjects with mild FD, those with extreme FD experiences had increased risks of frailty (1.34, 95% CI: 1.26-1.43). Subjects exposed to hunger at different ages all had an increased risk of frailty, and subjects who had FD during ages 6-12 (1.15, 95% CI: 1.09-1.22) were more likely to have an increased risk of frailty than those who had experienced FD in younger ages. The interaction of experience of FD at ages 0-6 and the experience of FD at ages 6-12 is not statistically significant after adjusting all covariates. CONCLUSIONS: Our findings suggest that childhood FD exerts long-lasting effects on frailty among older adults in China. The prevention of childhood FD may delay or even avert the emergence of frailty in people of middle-age and old age.

The Association between Purine-Rich Food Intake and Hyperuricemia: A Cross-Sectional Study in Chinese Adult Residents.

OBJECTIVE: To explore the correlation between purine-rich food intake and hyperuricemia in Chinese adult residents. METHOD: A cross-sectional study was conducted on the purine-rich food intake of Chinese adult residents based on the China Health and Nutrition Survey (CHNS) in 2009. The subjects were divided into hyperuricemia group and nonhyperuricemia group according to serum uric acid level, and the differences of the sociodemographic information (age, gender, and region), health status (weight status, blood pressure, blood sugar status), living habits (alcohol consumption, smoking status) and food intake (purine-rich food, other food) were compared between the two groups. Logistic regressions investigated the associations between the daily intake of purine-rich food (animal-derived food and legumes) and hyperuricemia. RESULTS: Eventually, 6813 subjects were included in our study, 1111 of them had hyperuricemia. The intake of seafood, legumes, red meat, and poultry all increased the risk of hyperuricemia (p < 0.05), while the intake of purine-rich fungi and purine-rich vegetables did not affect the occurrence of hyperuricemia. Animal-derived food was the main source of purine-rich food consumed by Chinese adult residents (140.67g/day), which had a great impact on hyperuricemia. Finally, after adjusting for gender, age, region, body mass index (BMI), alcohol consumption, hypertension, and refined grains intake, the risk of hyperuricemia increased by 2.40% and 1.10% for each increase of 10 g in animal-derived food intake (OR = 1.024, 95% CI: 1.018-1.030) and legumes intake (OR = 1.011, 95% CI: 1.003-1.019), respectively. CONCLUSION: The intake of animal-derived food and legumes were positively correlated with the occurrence of hyperuricemia. Controlling the intake of animal-derived food and legumes would be more beneficial to controlling the risk of hyperuricemia.